MRI findings in brain death

Case contributed by Dr Shekhar Kalia

Presentation

Background of chronic renal failure, status post renal transplant. She developed sepsis with toxic myocarditis and eventually had cardiac arrest and hypoxic-ischemic brain injury.

Patient Data

Age: 25 years
Gender: Female

MRI Brain

MRI

There is tonsillar herniation, loss of intra-arterial flow voids signal, diffuse cortical high signal intensity and swelling of cerebral sulci on T2WI, effacement of bilateral lateral ventricles, high signal intensity in cerebral and cerebellar hemispheres on DWI due to cytotoxic edema and no significant blooming on GRE. 

Case Discussion

MR findings in a case of brain dead patient are usually diffuse swelling of the cerebral gyri and cerebellar cortex, demonstrating iso-hypointense signals on T1WI, getting iso-hyperintense on T2 WI suggestive of hypoxic-ischemic brain injury, with associated tonsillar herniation, effacement of bilateral lateral ventricles and loss of normal flow voids in the intracranial portions of both internal carotid arteries. MR angio may show a paucity of intracranial vessels at/above the level of the supraclinoid portions of the bilateral internal carotid arteries.

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